Reform Is Heating Up In Mississippi

Mental health reform has lagged unconscionably in Mississippi for years. Now things are really heating up in Mississippi, and it is not even spring yet.

A little background is in order first. Mississippi has an uncomfortable political situation that my state of North Carolina had for the last four years and made reform and budgetary cooperation almost impossible. The governor and attorney general of North Carolina before this past November’s election were from opposing political parties and were political rivals. I shall not go into a political review or rant over this, as we all have had too much of that sort of thing over the last year and a half at the national level and everywhere else. In any case, the governor of NC was voted out and the attorney general took his place as governor. While Mississippi may not have quite the same political situation [and I hope they do not, I would not wish what we in NC went through the last 2 years on anyone, it was awful], the two top political officials of the state are sniping, are not friends it sounds like and certainly not working together on many matters including mental health reform.

Things have apparently gotten worse in Mississippi in late February when MS Governor Phil Bryant made a demeaning pseudo-Huey Long colloquialism, to “Gimme some of that mental health reform.” Had I been present in the governor’s audience, I likely have muttered under my breath, that this is not ‘ol time religion,’ nor is it the movie ‘Oh brother, where art thou.’

The attorney general Jim Hood had even stronger reactions than I, in his newspaper opinion piece in the Jackson Free Press newspaper of the capital of Mississippi, “Governor Obfuscates with Call for ‘Gimme some of that mental health reform.’ The attorney did himself no favors either as he excoriated the governor literally charging that the governor was taking monies of the Missisissipi taxpayers for noble causes such as mental health reform [this was implied in the article] and giving them to “his” “huge corporate benefactors.” Whew, as I stated in my title, things really are heating up, down there…

But it turns out that the attorney general Mr. Hood may know more of which he speaks and has likely a compelling motive for supporting genuine mental health reform in MS. He states in the above-referenced article that he is defending the state of Mississippi against a number of lawsuits regarding mental health reform. Many observers of the national mental health reform movement have been observing the travails of MS as lawsuit after has been brought against the state for huge and serious lapses, gaps and just plain inadequate state and local level mental health services. As another article, “Mississippi Still Faces Merged Mental-health Lawsuits,” and detailed in “In the Statehouse and the Courtroom, Mental Health is Embattled,” also published in the Jackson Free Press, MS now faces a consolidated federal lawsuit by the Department of Justice and many other parties including the Southern Poverty Law Center. The second article gives a great deal of background on the new lawsuit, Troupe vs. Barbour [as in the former governor, Haley Barbour of a few years ago]. It also details the difficulties that are preventing the politicians from coalescing into a working coalition to get something done. [Gee, where have I seen that before in some august legislative body?]

Things are so bad that the Jackson Free Press editors have weighed in on the process in their call for positive action and an end to the political paralysis, “Stop the Mental Health Politicking.” In reading through the editors’ exhortation to stop the infighting and to get to work on the issues, I was struck by the similarities in the MS logjam with many others in states who have or are still struggling to come to terms with mental health reform. The editors angrily state outrights that MS’s mental health programs have been “shrouded in secrecy,” and that the deficiencies have been known and ignored by the state’s legislature “for decades.” Not ringing endorsement of the past or present efforts.

And the editors, as the voice of reality, [when did politicians ever pay attention to that? Answer: only when they have to, as one anonymous wag stated eons ago], reform will take large efforts, closing some institutions [angering workers, local economies etc.], and a lot of money. And when one gets to the stage of “talking serious money,” as the saying goes, the specter of taxes, new revenue streams, cutting other vested interests, all come into play. And especially in the South sometimes, the code is to try to be polite and not offend anyone. [I speak as a transplanted pseudo Southerner from the South(west) who has spent more than 3/4 of my adult life in the American South].

So it will be interesting to watch in the coming legislative session or sessions, whether the government of Mississippi can collectively come together for the benefit of patients, providers and all the other groups and peoples with interests in mental health care delivery, and construct something that works. If they do not, I am sure the “feds,” will help them get motivated to do so. But solutions are borne out of compulsion often do not have the self-generated altruism and pride to do something positive, and fall apart as soon as the “occupying force,” leaves, whether it is Iraq in our time, or Reconstruction in the American South after the Civil War, or the Gaza Strip in the Middle East. So stay tuned to the coming jockeying, political horse trading, and whatever else it takes to enact and implement mental health reform in Mississippi. It will be interesting.

 

Washingston State Hospital System Fined

IN a very recent story of less than a week ago, entitled: “Washington accrues almost $7.5 million in contempt fines,” written by Martha Bellislea of the Associated Press published in many major newspapers across the country, the sad story of the travails of Washington’s Western State Hospital continues to showcase the plight of a number state public psychiatric hospitals.

 

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Solitary Confiment: New Data and Food for Thought

In an intriguing article/newsletter/blog post, “REPORT OFFERS RARE DATA ON SOLITARY CONFINEMENT IN UNITED STATES” real data is offered on solitary confinement in the American prison system. The numbers are impressive. This article took its information from a report, “Aiming To Reduce Time-In-Cell.” published by “The Association of State Correctional Administrators, of The Arthur Liman Public Interest Program, Yale Law School in November 2016.

The report noted that “In the fall of 2015, 67,442 people were locked in a cell for at least 22 hours a day, for 15 continuous days or more.” The data was collected from 45 of the 50 state prison systems, and, 48 of the 53 federal prison jurisdictions.

Texas, one of my ancestral home states, that has the highest number of death row inmates in a county jail in the country, Harris County of Houston, was second only to California in the total number of inmates in solitary.

As far as the mentally ill population is concerned, the article states, “Just over 54,000 incarcerated men are reported to have serious mental health issues in general population. A little more than 5,000 incarcerated men with serious mental health issues are in isolation.”

As a final note, the percentages of inmates in solitary confinement is quite striking in some states that have relatively small comparable total state populations.

Good News for New Hampshire, Not So Good News for Vermont

This writer keeps monitoring for positive developments in the realm of mental health reform and there are more than a few beginning to materialize around the country.

Of brief note is the fact that yesterday, Congress began finally to take positive legislative forward movement on Representative Tim Murphy’s “MHealth Care for Families…” bill to move it toward the Senate and the President’s signature. It is a huge step in the right direction.

Another positive development of note is that New Hampshire, according to a news report by KSL.com, “State hospital opens 10-bed mental health crisis unit,” on its online site for the states’ KSL TV channel, of July 5, 2016, reported that “A new 10-bed mental health crisis unit is open at New Hampshire Hospital after almost a delay of years.” The unit opened in Concord NH but illustrated immediately the enormity of the need in “little ol’ New Hampshire,” as we might say here in the South. On the day after it was opened it already had a waiting list of 23 people for emergency admission.

The article also mentions quite significantly that this entire effort was prompted by the state’s need to comply with a federal lawsuit over these very issues that had been initiated in 2013.

This observer sadly notes that even noble catch-up efforts in the nation’s and states’ mental health reform effort that are need, all good, and well intentioned, often are behind even when they get started but at least we are finally going in the right direction in places now.

But in the neighboring state of Vermont, things are not good. For months there has been well-deserved focus on something one does not hear much about anymore, since President Reagan broke the air controllers’ strike in the 1980’s and the decline of “organized labor” and “unions’ began in this country. Another striking feature of this situation has been that this new labor against management movement has involved healthcare professionals and mental healthcare professionals, which is truly almost totally anState opens new mental health crisis unit unheard of this country. This story has been a gathering storm since last year. It seemed to start in this writer’s mind a few years ago when whichever torrential “Nor’easter” storm savaged its way up the East Coast and into inland New England which is a bit of a rarity. That storm wiped out the state’s only public mental health hospital. Vermont has been limping along borrowing/leasing psychiatric inpatient beds in the state’s small private psychiatric inpatient hospital world. The state has relied most heavily on the Dartmouth Medical School’s inpatient psychiatric services for temporary relief.

This seemed at the time the best solution that could be had on a sort of moment’s notice state of urgency and emergency. But there was trouble in paradise so to speak. Labor problems began within months and built to the point where psychiatric nurses and psychiatrists themselves were fed up with working conditions which I am not privy to at all and began to voice their concerns at the state political level. Apparently, not much was responded to and too little positive corrective action appeared.

So they began to talk of work stoppages, strikes and other things that this writer associated with the United Mine Workers’ and United Steelworkers’ and Teamsters’ unions of the 1960’s and 1970’s that were every few years regular events. It was like Yogi Berra summarized in his most famous quote, “Deja vue all over again.” I personally know of psychiatrists through indirect sources that the psychiatrists were not just posturing to wangle higher wages, but were so serious that they were actively looking for jobs elsewhere, so strongly did the group of them feel about the deficiencies of patient care and availability. And Dartmouth and the State were caught in the middle I suppose, trying to generous and even-handed about all this.

This is yet another symptom of how bitter and unfortunately rancorous the processs of advocating for change can be anywhere, in any system, when the vehicle being ‘recalled and repaired and retooled’ can be at present when we attempt both short term and long term fixes that neither come easily nor rapidly enough. Again this writer will follow this story closely. I for one have never been on strike, though I went through them as a child decades ago as both my parents worked in the mining industry and this a regular every so many years event. And in the spirit of transparency, I know I could not do this and abandon my own patients.

 

 

 

New Troubles at Bridgewater State

A troubling development repeated itself at the famed Bridgewater State Hospital in Massachusetts, the place where the “Boston Strangler,” Albert DeSalvo, and the model for the cult classic movie of the 1860’s, “TheTiticut Follies,” occurred in late June. Another patient death by suicide within the facility.

In an  article entitled “Suicide spurs call for receivership at state hospital,” written by Katie Lannan of the STATE HOUSE NEWS SERVICE of the Newbury Port Daily News detailed the now repetitive tragedy. The Center had tardily reported on April 8, 2016 the death of Mr. Leo Marinio from Lawrence MA who killed himself by “ingesting large quantities of toilet paper while in isolation.” The local state advocacy organization, The Disability Law Center of Boston was calling for the entire facility to be placed into “receivership” and for the state to move on plans to transfer the control and operation of the hospital from the Department of Corrections to the Department of Mental Health.

Two aspects of this case are troublesome to this reader. First, the report of the death appears from this and media reports to have been delayed by weeks, and deceased had somehow in isolation been able to stuff enough foreign material into his throat to block his own airway and have time to die possibly unobserved.

Where I practice in the state of North Carolina, a death within any state institution whether it be a mental health, nursing home, hospital, or correctional facility, MUST be reported to the state authorities within a time limit of 24 hours. How this may have been delayed this long is astounding to this writer. Any unnatural or unexplained death even in any kind of hospital must so be reported within such a time frame to permit timely review and objective investigation of the cause of death and its circumstances, in a constant effort at self-correction of procedures and public airing of findings. We see the same kind of hush-hush delays nowadays in correctional, meaning police related deaths going on and receiving national news coverage when people die in police custody, being taken into police custody and it seems nowadays to take a judicial order to release timely records involved in such untimely deaths, such as on the spot videos that are so common now.

Second, this facility which has dealt with the forensically seriously mentally ill for generations, was run by the Department of Corrections, not an agency tasked with dealing with complexities of the mentally ill, though it must be stated that it is still possible and does happen also in mental health run forensic facilities that suicides occur. But it was a real surprise to this writer than Bridgewater State was not in my mind a “hospital,” as I had always thought, but a correctional facility with all that that circumstance can bring with it, such as overuse of isolation for corrective measures, and a lack of training in dealing with the seriously mentally ill.

The article sadly, in my mind reports that it had recommended such a move nearly two years ago the then Governor Duvall in 2014 because of similar issues detailed in this blog in which three deaths were involved.

This writer will watch this situation and monitor how the state machinery and political system handles this in the future and “report back” to the reader.

 

 

Corporate Psychiatry, and Greed Back Again?

This will be a full post but a ‘sidebar’ type as mentioned a few posts ago. This concerns one of the other states suddenly having a different type of problem in mental health reform service delivery. This involves what can happen when there is an attempt to privatize andsplit off the tasks of mental health care delivery by the mantra popular in certain political and business circles.

The enthralling idea behind privatization for traditionally “government services,” such as municipal water supply, trash collection, mass transit, public health care and mass pandemic protection, to cite an extreme example, is that governments cannot do the work as well, efficiently or cheaply as can the “private sector.” The political machines of the past century such as Tammany Hall and its decades of corruption and cronyism, the Daley political machine of Chicago where everything that got done, “got done,” often as a result of greasing the palm of your local alderman.

The ideological faith and belief that capitalistic, corporate business could always do a better job took strong hold of the political imagination of many in this country by the middle of this past century, emerging fully in the Reagan years largely in the form of “de-regulation,” and unfettering the business world from choking restraints of governmental rules, over-regulation that stifled innovation, efficiency and the free market and its potential productivity. Much of this was indeed true in certain sectors and up to a point. But the non-psychologically minded politicians who could not live in the world of ambiguity and human nature, would behave as if humannature and all its foibles and inherent sense of self interest would sacrifice for the betterment of the greater good of the Almighty Economy. A huge ideiological boo-boo in this paradigm shiftwas committed under this belief system, that began perhaps with President Reagan’s breaking the air controllers’ strike in the earliest years of his first term. But human nature asserted itself and those years came to be known as the “Age of Greed” years before our Wall Street crooks in nice looking suits broke the economy with hedge funds that were worthless, the housing mortgage bubble, insider trading and greed on a scale never seen or achieved in history.

So now we are witnessing states who have either given up

Continue reading “Corporate Psychiatry, and Greed Back Again?”

Kids are Still Stuck in ERs for Psych Beds

I apologize for this dated article and reference, but it reminds us all again of a problem linked to the overall policy and planning malfeaseance committed by mental health planners, bureaucrats, policty wonks, legistlators from the state to federal levels, in pursuing the idiotic policy of closure of psychiatric inpatient treatment beds and resources in the publich AND private areans. That error, is of course, one of the triads of haunting reminders of our big “boo-boo” of turning mentally ill out of treatment facilities too early, not having beds for them and not providing even a fraction of the known needed “community based resources,” and that is patients stuck in ERs around the country for days. This article came from the online edition of WXYZ News of Detroit MI, a state that was one of the earlies states to undertake “mental health reforom” under then Gov. John Engler in the decade of the 1990’s. This aticle was published in June, 2015 and showed that nearly 15 years after the start of mental health refrom in Michigan, children  were STILL waiting indeterminate periods of time for a child psychiatric bed to open up for their needed attention. In crisis, mentally ill boys and girls are waiting days for a hospital bed.

Continue reading “Kids are Still Stuck in ERs for Psych Beds”

Overall Mental Health Needs Nationally

This post will be a fact-based overview of the prevalence of mental health illness conditions and the burden nationally in the United States according to the National Alliance for the Mentally Ill and the National Institute of Mental Health on an annual basis.

I am writing this post at this point in time to also contribute to setting the stage for delving into the many complex issues that this blog will address in its future postas and tasks. These issues will range from  the staggering seeming increase in demand for mental health services all sectors of our American healthcare system, and many sectors in which we have neglected and actually delayed or even faced the necessity to institute regular and proximately closely situated competent mental health services such as school based clinics and for adults in the workplaces. Currently in the last 10 to 15 years we have had continuing bitter reminders of the needs for mental health services in the schools by the occurrence of mass shootings both by students and by adults in school schools. Prior to that in the 1980s and 1990s we had so many incidents of mass shootings by disgruntled employees of the US postal system that it became a national meme and joke to say that someone had  “gone postal.”

Continue reading “Overall Mental Health Needs Nationally”

Private Psych Units Close and Open

As the number of state hospital inpatient psychiatric beds continue to decline across in the country in an now well known ill advised and foolish move, private psychiatric units are also both closing and opening as the “market” struggles to either stay profitable in the face of continually declining incomes and reimbursements and higher costs, or, to take a commendable stand in seeing their “mission” as providing a heartfelt mission to serve their local communities in need of inpatient psychiatric beds. This is especially true in non “big U”, big university medical center cities, ordinary cities where the private sector is now beginning to inherit the burden of psychiatric care crisis around the country. Almost always these services (no surprise) are “loss leaders,” like sales a groceries stories that are money loser but get grocery shoppers in the door to buy other items that are profitable. But in inpatient mental health there are no heart bypass surgeries or such that are such gross moneymakers in the rest of American medicine.

Continue reading “Private Psych Units Close and Open”

Private Psychiatric Sector is Re-Awakening

One of the unspoken “white elephant in the room’ disturbing trends in the long slow 20 year disintegration of intensive, vitally needed, inpatient, hospital based psychiatric care delivery system has been the inexorable closure of beds everywhere. I do not honestly know that statistics of the percentage of private psychiatric beds that have closed since the early 1990’s when the trend accelerated, but it has been very substantial.

As they say in trite stories designed to bore the listener, “it all began in…”  the early 1990’s when the bandit organization called Charter Hospitals [read the book BEDLAM by New York Times long time investigative reporter who is still writing, Mr. Joe Sharkey, for an expose of how a few national private for profit psychiatric mills like Charter operated in those days. Instead of “pump and dump,” those outfits operated on the financial principal of “vacuum and dump,” meaning keep the patient inpatient till their insurance benefits ran out, and then arrange a discharge–quickly. Charter went bankrupt as most of us ethical practitioners knew it eventually would in the early 1990’s. In the few other locales that I have practiced, other than Durham NC and western North Carolina, I always knew the refrain “never have Charter on your CV.” Among ethical practitioners it was a blight. I recall a  personal incident where in one pra1930e Southwestern resident sister, did much more than I could to help them, I was approach my first week in my relocated and family driven need to work there, by a Charter “professional relations representative.” He came at the end of my long working days in the evening hours and was obviously irritated at having to wait so long as he was not accustomed to shrinks who worked past 6 p.m. I was puzzled as he carried a brand new bag of a complete set of golf clubs.{Disclaimer: I do NOT play golf]. He started his preamble and then launched into his pitch that I would be deserving of a shady sounding financial arrangement if I referred inpatients to the two then local Charter facilities. I would also be given an all expenses cruise for my wife and myself and have my staff credentials all done in a week or so. As it dawned on me nature of the arrangements being offered me and their inherent dishonesty, my Texas temper began to boil. Knowing me from years of analysis I knew I had to keep it under control or I would repeat my father’s mining engineering WWII approach to leadership in the mines he oversaw when I was growing up: throw the guy THROUGH the wall [my father was a true giant of of a man and one of the true “Four Horseman of Texas” high school football named after the Four Horseman of Notre Dame. I remember exercizing every bit of self control I ad and coldly as possibly with the most moral opprobrium, I could muster, telling him in civil but no uncertain terms to “get out” and take his bribes with him. I remember he was flabbergasted, never expecting than any greedy practitioner would turn down such a wonderful offer. As a final addendum, there was a salary offer couched in all this that would supplemented by an undisclosed sum with every referral. Such were the operations of Charter and at least some other national psychiatric chains, such as “NME” written about by Joe Sharkey.

But the bad news about Charter cratering all in a week or two in the 1991 or so [that year may wrong] was than a few thousand private psychiatric beds were lost the country over. And that started the trend of private psychiatric beds closing and private units downsizing all over the country as the reimbursements from private insurance companies cratered also. And that is the largely forgotten co-contributing cause to our present day mental health care crisis.

My next blog post in a week or two, I hope will address that legislation moving through Congress that will seek t redress the coverage inequities that still plague private hospitals who still, God Bless Their Souls, who operate inpatient psychiatric units. They ALL do so at a loss. Like a loss leader at a grocery store except in health care you cannot refer every psych inpatient for expensive surgery and make up the loss like you can at the steak counter in a grocery store. These hospitals do so out a sense of mission to the communities and because nobody else will.

But finally the psychiatric, bean counter, local legislative world is waking up partly due to the overcrowding of jails everywhere with the severely mentally ill who cost gobs of money to house, care for and treat well enough to retain accreditation of correctional review bodies, the rise of the mentally ill homeless even in small towns, as they said in the old movie “The Music Man,” ‘right here in River City! And the never ending now weekly spate of mass shootings at least enough of which are perpetrated by a particular brand of mentally ill for the most part that is fast becoming the shameful distinguishing news feature of American around the world. But debate is for another post…

A recent article, “Centra applies to add beds to psychiatric unit at Virgina Baptist,” in Lynchburg VA, published at NewsAdvance.com, is a good example of a relatively novel and much needed trend in the slow turn-around in the re-construction of mental health care in this country. Centra Health, a private hospital holding corporation is doing what I hope and assume is a brave thing, entering into the world of inpatient psychiatric care, likely in the hopes of better things, i.e., financial support, to come. Wake up Congress, this effort starting to happen elsewhere is bourne of desperation as states and local regional health care entities try to start filling a gap that is now upon us that imperils us and patients in many ways. I am not a dyed in the wool free market Republican but this is an example the market doing the right thing, seeing a need, and entering to fill it. But it needs support at a large level. And attention legislators: IT IS GOING TO COST REAL MONEY.

Centra hopes to add 8 to its existing psychiatric 37 beds which is impressive. It is clear from the article they saw the need locally and responded.

And why did this happen? Ask State Senator Craige Deeds now well known to the nation as one of our most well placed mental health advocates, whose son Gus suffered the ultimate price of unavailability of local mental health care too late, suicide, after having stabbing his father nearly two years and highlighting in a personally tragic way our current mental health care delivery crisis plight.

The answer is simply that states across the country since the 1990’s have sought to save monies in the multiple economic bubble  busts, and recession, by slashing mental health budgets, closing state hospital psychiatric beds and neglecting the decades long disparities in mental health insurance reimbursement that have drive the private psychiatric care sector into a shadow of its former self nationally. My own training university, a powerhouse and truly deserving prestigious care and research organization, now has far fewer private inpatient psychiatric beds than when I trained there in the 1970’s and depends upon a local private hospital with a far larger private psychiatric inpatient service to meet those needs. Most of the university’s now few inpatient psychiatric beds are funded by research grants and funds that is the reality facing many such prestigious university medical centers that one would assume are rich and powerful beyond belief. Not so anymore.

More to come on this topic soon.